Anterior Chest Wall Reconstruction After Total Sternectomy for Solitary Metastasis From Thyroid Carcinoma: A Case Report of a Wire-Only Technique.

Solitary metastasis of papillary thyroid carcinoma in the sternum is rare. The management and reconstruction of such cases pose a challenge. Surgical removal with clear margins provides local control and relieves the symptoms. However, chest wall reconstruction after total sternectomy remains a complex procedure. A 40-year-old man presented with a painful anterior chest wall mass and a thyroid nodule. Positron emission tomography-computed tomography (PET-CT) revealed a solitary hypermetabolic lytic lesion involving the sternum and a Fluorodeoxyglucose (FDG) - a radioactive glucose analog used primarily as a radiotracer in PET scan- avid lesion in the right thyroid lobe. Biopsy confirmed the presence of malignant papillary thyroid cancer. After undergoing multidisciplinary evaluation, the patient underwent a six-session chemotherapy regimen of paclitaxel-carboplatin; restaging showed no evidence of extra-metastatic disease. The patient underwent total thyroidectomy, followed by radical 'en bloc' total sternectomy with resection of the manubrium, sternal body, xiphoid, and medial ends of both clavicles and first to seventh costal cartilages. Utilising a modified Robicsek stainless steel wire-only technique, a 15×10 cm anterior chest wall defect was reconstructed with a semi-rigid neosternum without any prosthetic mesh or muscle flap. The patient was extubated after 6 h, showed no paradoxical respiration or chest wall instability, and achieved primary healing. One month later, the patient showed complete functional recovery. Total sternectomy with modified Robicsek wire-only reconstruction is a safe, effective, and economical technique in patients with isolated sternal metastases from papillary thyroid cancer (PTC). This method is especially beneficial for patients whose prosthetic materials are prohibitively expensive or unavailable.